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15050176N1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21286 RUMFORD DR CONTRACTOR: SANJAY & NAMRATA PERMIT NO: 15050176 WADHWA OWNER'S NAME: SANJAY & NAMRATA WADHWA 21286 RUMFORD DR DATE ISSUED: 05/28/2015 OWNER'S PHONE: 7656817603 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL REMODEL (E) UPSTAIRS HALL BATH (42 S.F.) NO License Class Lic. 4 STRUCT L CHANGES. Contractor Date Revision #1 - Add scope of work to include Master Bathroom (52 S.F.) - Issued 8/7/2015 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $7000 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 32641021.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 YS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. f OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the I hereby affirm under penalty of perjury one of the following three California Healthi & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Section 25505, 25533, and 25534. p Section 3700 of the Labor Code, for the performance of the work for which this /1(1 limit is issued. Owner or authorized agent: Dateo certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply i with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date e CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21286 RUMFORD DR CONTRACTOR: SANJAY & NAMRATA PERMIT NO: 15050176 WADHWA OWNER'S NAME: SANJAY & NAMRATA WADHWA 21286 RUMFORD DR DATE ISSUED: 05/28/2015 OWNER'S PHONE: 7656817603 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL REMODEL (E) UPSTAIRS HALL BATH (42 S.F.) NO License Class Lie. # STRUCTURAL CHANGES. Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $7000 performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 32641021 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the S Date: granting of this permit. Additionally, the applicant understands and will comply Issued by: with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. RE -ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by for the for this the Health & Safety Code, Sect' s 25505, 25533, and 25534. Section 3700 of the Labor Code, the performance of work which Owner or authorized agent: Dater permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this pcmiit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9 18. Signature tW.,Uu.A_Date� CITY OF CUPERTINO FM__1 FEE ESTIMATOR — BUILDING DIVISION �.. :.,i.l r r -'. u1M frm, fi -=w' v, i-, h; -. .4'1'1 s �e � .... �i� M i. 7. ah. a�yy.�� �',".5y• �r5 f....Y .: 9 'eY 1 �. r� 1( i,.'1{: hr,..11,.;.. �(P, L ,.. . N �"'TI""!�2yy �4?"'S�f.�. ,, { :. �?"ke"r .i (,�. 1.. ��Y .: Y.F :kid ��-: j( �lS� V �4. �fJ ( C F 7'7� ,�' � F. �S fiy i .Y � .:;�1,�.,tk�6G�_r,.vs,�,�i„w. v'�.f. ,S�:I Te. 4r i'n.7� �.,4#.. .r i`i��at�+. •z; -s "'� ,�`;5�.,, xita 'S_ t..;::.,. , v . .r.»� tt.a �rtt:`�.v..p „-.e a�i:.vZ rn as �.,:� ADDRESS: 21286 RUMFORD DR DATE: 05/28/2015 REVIEWED BY: MELISSA Flee, Plan check APN: 326 41 021 BP#: %�� (p VALUATION: 1$7,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex A-Icch. lash. Fee: PENTAMATION PERMIT TYPE: 1 R3SFDREM WORK I REMODEL E UPSTAIRS HALL BATH 42 S.F. NO STRUCTURAL CHANGES. SCOPE Suppl. Insp. Fee:Q Reg. Q OT �.. :.,i.l r r -'. u1M frm, fi -=w' v, i-, h; -. .4'1'1 s �e � .... �i� M i. 7. ah. a�yy.�� �',".5y• �r5 f....Y .: 9 'eY 1 �. r� 1( i,.'1{: hr,..11,.;.. �(P, L ,.. . N �"'TI""!�2yy �4?"'S�f.�. ,, { :. �?"ke"r .i (,�. 1.. ��Y .: Y.F :kid ��-: j( �lS� V �4. �fJ ( C F 7'7� ,�' � F. �S fiy i .Y � .:;�1,�.,tk�6G�_r,.vs,�,�i„w. v'�.f. ,S�:I Te. 4r i'n.7� �.,4#.. .r i`i��at�+. •z; -s "'� ,�`;5�.,, xita 'S_ t..;::.,. , v . .r.»� tt.a �rtt:`�.v..p „-.e a�i:.vZ rn as �.,:� M 1 u: tv. �.r..:�R. 4y,t ...,.3• +" z ";.+. "t ,Y3,, c,;' 7i';' f;i;'�g:, rad .�0� ;�..I F. '� .s. �. � u _r �,7". ,'•'��,.. ��n cit �i-�LeC,..v7,'�`✓•si �. o. '. rn~'.urxznzC'.1+�i�'ir� R +7� � 1rech. Pk.,n ('heck 1,111mh. Phu, Check Flee, Plan check tree/,. Permil Fee; Plau)rb. Permit Pvc: 1;7e(.. Permit 1.1'C- ot/ler Aleck Ir7sr'. 0/iJf.7' 1,1e/J777) IYI,SI?. lnsr), A-Icch. lash. Fee: Phl,,,h. h1s)). rek': Ghtc. rrur,. Fee: Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: :ZdInblistrcative 1'c.e: 0 E) Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building or Structure 0 I A Tran el Doc,ulnenhalion T'e'es: a 1- �.. :.,i.l r r -'. u1M frm, fi -=w' v, i-, h; -. .4'1'1 s �e � .... �i� M i. 7. ah. a�yy.�� �',".5y• �r5 f....Y .: 9 'eY 1 �. r� 1( i,.'1{: hr,..11,.;.. �(P, L ,.. . N �"'TI""!�2yy �4?"'S�f.�. ,, { :. �?"ke"r .i (,�. 1.. ��Y .: Y.F :kid ��-: j( �lS� V �4. �fJ ( C F 7'7� ,�' � F. �S fiy i .Y � .:;�1,�.,tk�6G�_r,.vs,�,�i„w. v'�.f. ,S�:I Te. 4r i'n.7� �.,4#.. .r i`i��at�+. •z; -s "'� ,�`;5�.,, xita 'S_ t..;::.,. , v . .r.»� tt.a �rtt:`�.v..p „-.e a�i:.vZ rn as �.,:� M 1 u: tv. �.r..:�R. 4y,t ...,.3• +" z ";.+. "t ,Y3,, c,;' 7i';' f;i;'�g:, rad .�0� ;�..I F. '� .s. �. � u _r �,7". ,'•'��,.. ��n cit �i-�LeC,..v7,'�`✓•si �. o. '. rn~'.urxznzC'.1+�i�'ir� R +7� � 1rech. Pk.,n ('heck 1,111mh. Phu, Check Flee, Plan check tree/,. Permil Fee; Plau)rb. Permit Pvc: 1;7e(.. Permit 1.1'C- ot/ler Aleck Ir7sr'. 0/iJf.7' 1,1e/J777) IYI,SI?. lnsr), A-Icch. lash. Fee: Phl,,,h. h1s)). rek': Ghtc. rrur,. Fee: NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt oto 1_ Thoco fooc aro hacod an tho nroliminary information availahle and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 a.' 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel, Bath (<=300 sf) $645.00 IREMRESBAT Suppl. PC Fee: Q Reg. Q OT 1 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: :ZdInblistrcative 1'c.e: 0 E) Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building or Structure 0 I A Tran el Doc,ulnenhalion T'e'es: Strong Motion Fee: 1BSEISMICR $0.91 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 yST7BTOTAYS 51c. JB.L'i•,...,� ..�, �. ..:w -s- ., s'..:e::.,. $1.91 ',.4 PstSJ YI*sa „f i - Vk.�Si"i "as1 y $645.00e°{`� fiOTAL FEE Y rY Y -r s..,,C 4',+ ..c_ _ ?sem ,. m_, c>A'tl df�' esu :f u,:i $646.91 Revised: 05/07/2015 CITY OF CUPERTINO FEE ESTIMATOR — RITTT,DING DTVTCTnN A ADDRESS: 21286 RUMFORD DR. DATE: 08/07/2015 REVIEWED BY: PAUL APN: 326 41 021 BP#: 15050176 *VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 0.0 PENTAMATION 1GENRES PERMIT TYPE. WORK Revision #1 - Add scope of work to include Master Bathroom 52 S.F. SCOPE Mech. Plate Check. Platnab. Plan Cheek F.le Plrne Check illech. Permit Fee: Otherillech. hasj). Afcerh. hasp. Fee: Plumb. Permit Fee: Oilier Plumb lash. Plumb. Insp. Fee: Elec. Permit fee., Other Alec. hest. Elea leap. Fee: IVU*: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dlstrief. etc. L Tite.Qe fee.Q aro havod nn tho nrafiminnnr infnrcnnfins. -d n o -1" n acNcs�nfn 17-0nn/ #1— TI -0 Fn. _A'1_ ) ;-,r- FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? () Yes (D No $0.00 hours $143.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: (F) Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Feer Reg. 0 OT0 0 hrs $0.00 PNM Unit Fee: $0.00 PME Permit Fee: $0.00 Consiruc:tion Rix Adminislrfifive Fee: 0 E) Work Without Permit? O Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential e) Building or Structure 0 :1 � /ravel Documentation Iee.S': Strong Motion Fee: $0.00 1.0 hrs $143.00 Inspections ISTINSP Inspection, Hourly Bldg Stds Commission Fee: $0.00 SUBTOTALS". $0.001$286.00 TI)TAL`E� 777 $286.00 Revised: 07/02/2015